Active NPI
Dwight Jackson
- Community Health Worker
- Flatwoods, KY
National Provider Identifier
1013055896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 925 Daniels Dr
Flatwoods, KY 41139-1605 - Phone
- (606) 836-1886
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
925 Daniels Dr
Flatwoods, KY 41139-1605
Mailing address
PO Box 790
Ashland, KY 41105-0790
Phone (606) 329-8588
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30610026 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607644800000",
"number": "1013055896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 790",
"city": "ASHLAND",
"state": "KY",
"postal_code": "411050790",
"telephone_number": "606-329-8588",
"fax_number": "606-329-8195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "925 DANIELS DR",
"city": "FLATWOODS",
"state": "KY",
"postal_code": "411391605",
"telephone_number": "606-836-1886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DWIGHT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2020-12-11",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30610026",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flatwoods, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.